OBJECTIVES: To report the neonatal morbidity in fetuses with severe congenital diaphragmatic hernia (CDH) treated with fetoscopic endoluminal tracheal occlusion (FETO) and compare it with historical controls with less severe forms that were managed expectantly. METHODS: This is a prospective multicenter study on neonatal outcomes and prenatal predictors in 90 FETO survivors (78 left, 12 right) and 41 controls from the antenatal CDH registry with either severe or moderate hypoplasia who were managed expectantly. We also investigated early neonatal morbidity indicators, including need for patch repair, duration of mechanical ventilation and supplemental oxygen, age at full enteral feeding and incidence of pulmonary hypertension. RESULTS: Gestational age at delivery was predictive of duration of assisted ventilation (p=0.046), days on supplemental oxygen (p=0.019) and age at full enteral feeding (p=0.020). When delivery took place after 34 weeks, neonatal morbidity of FETO cases was comparable to that of expectantly managed cases with moderate hypoplasia. CONCLUSIONS: Fetal intervention for severe CDH is associated with a neonatal morbidity that is comparable to that of an expectantly managed group with less severe disease.